Musculoskeletal disorders among bank workers: a systematic review and meta-analysis

Abstract

Purpose

Bank employees are among the workers who are at a high risk of suffering from musculoskeletal disorders (MSDs) due to inactivity and prolonged sitting as well as static and poor postures. This study was conducted with the aim of systematic review and meta-analysis of the prevalence of MSDs among bank employees.

Materials and methods

This review followed the PRISMA guidelines and its protocol is registered in PROSPERO with the code CRD42024509728. Using several databases including PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar, related studies were extracted without time limit until February 7th 2024. Simple random effects model and I2 index were used respectively for performing meta-analysis and determining heterogeneity between studies. Finally, data analysis was done using the software STATA version 14.

Results

After conducting the initial search, 1837 studies were identified in the information sources. After careful consideration, 28 studies were included in meta-analysis. The meta-analysis results revealed that 67.84% (95% CI: 61.21–74.47, I2 = 97.4%, P < 0.001) of bank employees suffer from MSDs. These disorders affect various areas of the body with the following prevalence rates in the low back (49.19%), neck (46.11%), upper back (42.08%), shoulder (34.88%), hand (25.40%), hip/thigh (19.29%), knee (17.86%), ankle/foot (16.37%), and elbow (12.53%).

Conclusions

The high prevalence of MSDs among bank employees is a concern, especially due to their sedentary behavior. It is important to increase awareness among bank employees about the risk factors of MSDs and design interventions to reduce their sitting time. Additionally, adjusting workstations according to ergonomic recommendations can help prevent MSDs in this occupational group.

Introduction

Musculoskeletal disorders (MSDs) caused by cumulative trauma are prevalent health issues and occupational disorders globally. These problems stem from various stressors, including repetitive motions, poor posture, excessive force, and localized mechanical stresses [1]. Generally, work related musculoskeletal disorders (WRMSDs or WMSDs) refer to injuries affecting body tissues, including muscles, joints, tendons, ligaments, nerves, bones, and localized blood circulation, which are primarily triggered or worsened by the type of work or the conditions of the workplace [2]. These disorders not only affect a person's health but also lead to low work productivity and impose a significant financial burden on society through sick leave, absenteeism, and early retirement [3, 4]. WRMSDs are one of the major concerns in occupational health and one of the most important key issues for ergonomists worldwide [5].

The use of computers in modern office work has transformed the nature of jobs, leading to a more sedentary lifestyle for many employees [6]. In general, in an office setting, employees typically spend over six hours of their workday inactively, and this accounts for approximately 71–80% of their total working time [7]. Spending more time sitting during the day can pose health risks for people [8]. It is important to highlight that a sedentary lifestyle and sedentary activities can lead to various health issues, including MSDs, especially in the upper limbs and neck, obesity, type 2 diabetes, different types of cancer, cardiovascular diseases, cognitive disorders, and depression [9, 10]. When performing administrative tasks, the muscles can become tense from prolonged sitting, leading to fatigue, and if proper recovery is not achieved, it can result in long-term health issues [11]. Additionally, spending long hours at the computer can heighten the likelihood of developing upper limb MSDs [12]. Bank employees are one of the several groups of workers who have to endure long periods of sitting and inactivity. Among different ergonomic risk factors in banking sector, we can mention improper and static posture and frequent use of computers. Therefore, performing the duties of bank employees makes them susceptible to MSDs due to the nature of this job [13].

The findings of a research study indicated that prolonged sitting is associated with a gradual rise in musculoskeletal discomfort over an extended period [14, 15]. In another study, it was found that sedentary behavior and infrequent changes in posture are significant risk factors for MSDs in office workers [4]. It has been found that there is a significant relationship between the amount of time spent sitting and working at a computer and experiencing neck and back complaints [16, 17]. In a different study, it was discovered that there is a direct relationship between the amount of time spent using a computer each day and experiencing pain in the neck, upper back, and lower back [18]. Generally, the musculoskeletal health of employees can be influenced by various factors such as individual characteristics, physical demands of the job, psychosocial factors, and organizational elements [2, 19, 20].

Recently, several systematic reviews and meta-analyses have been conducted to estimate the prevalence of MSDs among seated occupations, such as computer users, drivers, and sonographers. The findings from the review of computer users indicated that the magnitude of work-related MSDs varied between 33.8% and 95.3%, with the lower back, neck, upper back, and shoulders being the most affected areas [2]. Other meta-analysis research conducted among taxi and truck drivers identified similar regions as the most common sites for musculoskeletal pain, also highlighting a high prevalence among them [21, 22]. In another review study conducted among sonographers, a very high prevalence of musculoskeletal disorders was observed, with the most dangerous areas for suffering from these disorders being the neck, shoulder, upper back, and lower back [23]. Additionally, a review study carried out among dentists indicated the annual prevalence of musculoskeletal disorders in each area of the body between 68 and 100%. The most prevalent areas for musculoskeletal disorders among these professionals were the lower back, shoulder, and neck [24].

The high prevalence of MSDs among employees in sedentary occupations has been discussed in comprehensive literature reviews. However, to the best of our knowledge, no comprehensive study was found that investigates the overall prevalence and types of MSDs among bank employees, although several studies have examined the prevalence of MSDs among employees in this occupational group. Considering the importance and necessity of investigating this issue, it was decided to conduct a systematic review and meta-analysis for two purposes: first, to increase the available information in the field of MSDs among bank employees, and second, to provide an important resource for planning and designing educational programs and ergonomic interventions by health managers to control the prevalence of MSDs among bank employees.

Method

In the present study, a systematic review and meta-analysis were conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [25]. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42024509728. The stages of search strategy, screening, selection of studies, qualitative assessment, and data extraction were performed sequentially based on the PRISMA guidelines. Two researchers were asked to select, qualitatively assess, and extract studies separately. At the end, a decision was made based on a group discussion in case of difference of opinion between the two researchers.

Information sources and search strategy

In this systematic review and meta-analysis, a comprehensive search was conducted to extract relevant studies from various sources including PubMed, Scopus, Web of Science, Google Scholar, conference and congress articles, and the references cited in the selected articles and systematic review studies. Specific words from relevant articles, Medical Subject Headings (MeSH), and consulting with scientific experts were used to ensure the extraction of valid keywords for this study.

The search strategy was implemented for all databases by including valid keywords such as "Bank*", "Bank-employees*", "bank staff*", "Bank workers*", "Bank office workers*", "Bankers*", "Musculoskeletal complaint*", "WRMSDs", "WMSDs", "Work related Musculoskeletal disorder*", "MSDs", "Muscle problem*", "Muscle strain*", "Musculoskeletal disease*", "Musculoskeletal symptom*", "Musculoskeletal problem*", "Musculoskeletal disorder*", "Musculoskeletal pain", "Back pain*", "Neck pain*", "Dysfunction*", "Arthritis joint*", "Arthritis bone*", "Shoulder pain*", "Elbow pain*", and "Hand pain*", as well as using various search fields and operators. It should be noted that the searches were conducted without a time limit until until February 7th 2024. The search strategy for all databases is presented in Table 1.

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Inclusion criteria

The inclusion criteria were established based on the PECO (Population, Exposure, Comparison, Outcome) framework, which specifies the population (bank workers), exposure (working in a bank), comparison (any), and outcome (musculoskeletal disorders). Consequently, all studies that investigated and reported MSDs among bank employees until February 7th 2024 were included.

Exclusion criteria

Interventional studies, case reports, reviews, letters to the editor, and reports on the prevalence of musculoskeletal injuries caused by accidents were considered as the exclusion criteria for this study.

Selection of studies

In order to organize the findings, all initially searched studies were imported into EndNote X7 software. Duplicate articles were eliminated, and the titles and abstracts of the remaining articles were reviewed. This process helped to identify potentially relevant research. Subsequently, two researchers separately examined the full text of the potentially relevant studies. At the end, the final articles were selected to be included in the study. It is worth mentioning that any study that examined the prevalence of musculoskeletal disorders among bank workers was included in the study if it did not meet the exclusion criteria. Most of these studies were cross-sectional.

Qualitative assessment and data extraction

In this research, the quality of the selected studies was evaluated using the evaluation tool for cross-sectional studies (AXIS) [26] with a score range of 0–20. Studies with a score of 12 or higher were included in the meta-analysis [27, 28]. It should be noted that no study was excluded in the present study. Then, the details including the name of the first author, studied sample size, average age of the studied population, tools, number of participated men and women, and the prevalence of MSDs and their types were extracted by two researchers independently. These data were recorded in a pre-prepared checklist. In this process, two evaluators independently and separately entered the scores for different items into the checklist. Since the items being scored were the same, the scoring by the two evaluators should generally be similar. In cases where there were discrepancies in the scores, a third evaluator provided the scoring, and their scores were considered as the final decision.

Statistical analysis

Data including the prevalence of MSDs and sample size were extracted from the studies. Then, the variance of the studies was calculated using the binomial distribution, and a weighted average was used to combine the prevalence of MSDs from different studies. The selected studies were weighted using inverse variance, and a simple random effects model was used for meta-analysis. The degree of heterogeneity between studies was calculated using the I2 index, and publication bias was assessed using Begg’s test. Heterogeneity levels less than 25%, and 50–25%, 50–75%, and above 75% indicate no heterogeneity, and moderate, high, and very high heterogeneity, respectively [29]. The analysis was conducted using STATA (version 14). A significance level of less than 0.05 (p < 0.05) was considered.

Results

Systematic review results

After the initial search across different information sources, a total of 1,837 articles were found. By eliminating duplicate papers, 1,758 studies remained to be screened. After screening the titles and abstracts of the articles, the research team reviewed the full texts of 65 studies that were more likely to contain relevant data. At this stage, upon examining the full texts, it was found that a significant number of studies (22 studies) reported musculoskeletal disorders that were actually musculoskeletal injuries resulting from accidents. Therefore, these studies were excluded, as the aim of the current study was to estimate the prevalence of work-related musculoskeletal disorders arising from cumulative injuries. Moreover, the study population in several studies consisted of a combination of bank employees and other administrative staff; these studies were also excluded, as our study focused solely on bank employees. Finally, 28 studies were selected for quality evaluation and were eventually included in the meta-analysis phase (Fig. 1).

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The meta-analysis involved 5209 bank workers to investigate the occurrence of MSDs. 21 out of the 28 studies focused on the overall prevalence of MSDs among a total of 6740 individuals. More details about the included studies are provided in Table 2.

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Meta-analysis results

The results of the meta-analysis, based on 21 studies that reported the overall prevalence of MSDs among bank workers, show that the prevalence is 67.84% (95% CI: 61.21–74.47, I2 = 97.4%, P < 0.001). The I2 index indicates a high level of heterogeneity among the studies analyzed (Fig. 2). It is important to highlight that, Because of this high level of heterogeneity characterized by the I2 index, a random-effects model was utilized in the meta-analysis. This model is preferred in meta-analyses and systematic reviews because it effectively addresses the variability among different study outcomes. It operates under the assumption that the actual effect may differ from one study to another, which improves the applicability of the findings to larger populations. Furthermore, by minimizing bias from study selection and concentrating on the range of diverse effects, it can yield more precise estimates of the true effects. Additionally, Begg’s test (P = 0.866) shows a negligible publication bias in the prevalence of overall MSDs among bank workers (Fig. 3).

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The results of subgroup analysis indicate that there are different prevalence rates of MSDs in various body areas among bank workers, as shown in Table 3. The low back has the highest prevalence rate at 49.19% (95% CI: 42.88–55.51, I2 = 97.2%, P < 0.001), while the elbow has the lowest rate at 12.53% (95% CI: 10.62–14.45, I2 = 78.6%, P < 0.001). In addition, I2 values are significantly elevated in all body areas, except the elbow. The results of Begg’s test suggest that there is a significant publication bias in the occurence MSDs of the hand.

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Discussion

This study aimed to investigate the prevalence of MSDs among bank employees, and 28 studies were selected for meta-analysis. The results showed that the overall prevalence rate among bank employees is 67.84%, and the prevalence rates of MSDs in the low back (49.19%), neck (46.11%), upper back (42.08%), shoulder (34.88%), hand (25.40%), hip/thigh (19.29%), knee (17.86%), ankle/foot (16.37%), and elbow (12.53%) were estimated. As can be seen, the highest prevalence was observed in the back region.

In a review study, the prevalence of MSDs among bank employees was between 60–80%. The prevalence rates of MSDs in the shoulder and neck of office workers were also reported between 40–80% [57]. In addition, another review study reported that the prevalence of MSDs among computer users ranges from 33.8 to 95.3 percent, and the low back, neck, upper back and shoulder had the highest prevalence, while the elbow, hip/thigh, knee, wrist/hand and ankle/foot had the lowest prevalence [2]. In a review study, Joseph et al. reported that the prevalence of MSDs among professional drivers was between 43.1% and 93%, and the most common type of MSDs was related to the lumbar region (53%). Additionally, the neck, shoulder, and upper back had high prevalence of MSDs [58]. Based on the mentioned studies, it was expected that the prevalence rate among bank employees would be also high.

The prevalence of MSDs among other occupations has also been the focus of several studies. In Tolera et al.'s study, the prevalence of MSDs among sanitation workers was reported to be 40.52% [59]. According to another study conducted among nurses, the prevalence of MSDs ranged from 33 to 88%. The most common areas for the prevalence of MSDs were reported to be the back and shoulders [60]. Das et al. examined the frequency of musculoskeletal symptoms in handicraft workers. They found that the prevalence of MSDs ranged from 38.5% to 100%, with the most commonly affected areas being the neck, back, knees, and upper limbs [61]. Epstein et al. reported a pooled prevalence of pain ranging from 35 to 60% among physicians in a meta-analysis study [62]. In the review study by Jacquier-Bret et al., it was reported that the highest prevalence of MSDs was related to the lower back (over 60%), shoulder, and upper extremities (35–55%), with the main causes being the maintenance and repetition of awkward postures [63]. According to the findings of Tavakol et al., the prevalence of MSDs among operating room personnel ranges from 58 to 90%, with the lower back being the most commonly affected region [64]. Additionally, meta-analyses involving teachers, emergency medical personnel, and sonographers indicated overall disorder prevalence rates of 68%, 56.52%, and 75.8%, respectively [19, 23, 65]. Upon comparing the findings of the studies mentioned earlier with our current study, it can be concluded that the incidence of MSDs among bank employees is higher than that of sanitation workers, physicians, and emergency medical personnel, but lower than that of handicraft workers, operating room personnel, and sonographers. However, it does not show much difference compared to the prevalence of MSDs among nurses and teachers.

Among the studies analyzed, the highest overall prevalence of MSDs reported was 90%, while the lowest reached 33.8%. The considerable heterogeneity noted in this meta-analysis may indicate significant variations in the findings of the original studies, which could be attributed to factors such as the study design or the tools used for assessing MSDs. This level of heterogeneity implies that the results may have been affected by the unique characteristics of each study. However, employing a random-effects model in this meta-analysis likely enhances the generalizability of the results to larger populations, as it effectively accounts for differences among various study outcomes.

To control and reduce the prevalence of MSDs among bank employees, reducing the risk factors in their jobs probably help. Tahernejad et al. identified sedentary behavior and low frequency of posture changes as significant risk factors for MSDs among office workers [4]. It is worth noting that the effect of long-term computer use on MSDs has been confirmed in various studies [53, 66, 67]. Based on a review study, it was discovered that incorporating active rest and changing body posture can be beneficial in preventing MSDs and back pain [68]. Furthermore, several studies have also pointed out that poor working posture and improper workstation design are significant contributors to MSDs in office employees [69, 70]. Similarly, in a recent review, long-term use of computers, older age, repetitive movements, female gender, improper posture, lack of exercise, and lack of ergonomic training were among the factors affecting MSDs among computer users [2, 3, 71].

In the present study, it was shown that the prevalence of MSDs among bank employees is almost high. As it is known, if this high prevalence is not dealt with, the harmful consequences will affect the individual and society. Ergonomic and educational interventions can probably play a significant role in preventing MSDs in this occupational group. In general, the data obtained from this study presents valuable evidence for further research by researchers and can be used to provide guidelines and implement health policies in the workplace by the managers of organizations to reduce the occurrence of work-related health problems among bank employees.

Conclusion

Based on the findings, there is a high prevalence of MSDs among bank employees. Given the detrimental impact of MSDs on employees' workability and quality of life, as well as the associated high costs, it is recommended that stakeholders and health policymakers take measures to alleviate the burden of these disorders. Raising awareness about the risk factors of MSDs in the workplace, implementing ergonomic interventions, and regularly monitoring individuals for symptoms of these disorders may prove beneficial in managing MSDs among this particular occupational group.

Limitations

This study has some limitations that need to be addressed. One of the limitations is the variation in sample sizes, assessment tools, and different thresholds among the studies, which lead to heterogeneity. The inability to report the prevalence of MSDs based on gender due to the lack of data in the original studies is another limitation. Furthermore, conducting subgroup analyses based on the assessment tool was not feasible due to the limited number of tools used in the subgroups.

Data availability

All the data sourced from the articles listed in the tables within the manuscript.

Abbreviations

MSD:

Musculoskeletal Disorders

PRISMA:

Preferred Reporting Systematic Reviews and Meta-Analyses

MeSH:

Medical Subject Headings

WOS:

Web Of Science

NMQ:

Nordic musculoskeletal questionnaire

CMDQ:

Cornell Musculoskeletal Discomfort Questionnaire

CI:

Confidence Interval

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